Liu Rachel, Gitman Melissa R, Morris Andrew M, So Miranda
Department of Pharmacy, Michael Garron Hospital, Toronto, Ontario, Canada.
Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
Antimicrob Steward Healthc Epidemiol. 2023 Jan 9;3(1):e3. doi: 10.1017/ash.2022.353. eCollection 2023.
Febrile neutropenia (FN) is a medical emergency with significant morbidity and mortality for oncology patients, requiring comprehensive workup and timely antibiotic administration. We evaluated concordance with locally developed FN guidelines and outcomes of cancer patients admitted to general internal medicine at an academic teaching hospital.
We conducted a retrospective observational cohort study of patients admitted between July 1, 2016, and June 30, 2017, for FN. Patients were classified as having low-risk or high-risk FN according to their malignancy and chemotherapy. Primary outcome was the proportion of patients receiving guideline-concordant antibiotics within 48 hours of admission to general internal medicine. Secondary outcomes were the proportion of patients in whom empirical antibiotics were active against pathogens isolated, rate of antibiotic-associated adverse events, and in-hospital mortality. We used logistic regression to model relationship between FN risk and guideline-concordant antibiotics.
Among 100 patients included, 34 (34%) were low-risk FN and 66 (66%) were high-risk. Proportion of guideline-concordant empirical antibiotics was significantly lower among low-risk FN patients than high-risk patients: 12 (35%) of 34 versus 47 (71%) of 66 ( = .001). Empirical antibiotics were active against 17 (94%) of 18 isolated pathogens. The mortality rate was 3%, and 16% of patients experienced antibiotic-associated adverse events. Hematological malignancy and infectious diseases-trained physician involvement were associated with guideline-concordant prescribing, with adjusted odds ratios of 3.76 (95% CI, 1.46-9.70; = .006) and 3.71 (95% CI, 1.49-9.23; = .005), respectively.
Guideline concordance was low compared to published reports. Factors influencing appropriate antimicrobial prescribing in patients with FN warrant further exploration.
发热性中性粒细胞减少症（FN）是肿瘤患者的一种医疗紧急情况，具有较高的发病率和死亡率，需要进行全面检查并及时给予抗生素治疗。我们评估了在一家学术教学医院普通内科住院的癌症患者与当地制定的FN指南的符合情况及治疗结果。
我们对2016年7月1日至2017年6月30日期间因FN住院的患者进行了一项回顾性观察队列研究。根据患者的恶性肿瘤情况和化疗情况将其分为低风险或高风险FN。主要结局是在内科住院48小时内接受符合指南抗生素治疗的患者比例。次要结局是经验性抗生素对分离出的病原体有效的患者比例、抗生素相关不良事件发生率和住院死亡率。我们使用逻辑回归模型来分析FN风险与符合指南抗生素治疗之间的关系。
在纳入的100例患者中，34例（34%）为低风险FN，66例（66%）为高风险FN。低风险FN患者中符合指南的经验性抗生素比例显著低于高风险患者：34例中的12例（35%）对比66例中的47例（71%）（P = 0.001）。经验性抗生素对18株分离病原体中的17株（94%）有效。死亡率为3%，16%的患者发生了抗生素相关不良事件。血液系统恶性肿瘤和有感染性疾病培训经历的医生参与与符合指南的处方相关，调整后的比值比分别为3.76（95%CI，1.46 - 9.70；P = 0.006）和3.71（95%CI，1.49 - 9.23；P = 0.005）。
与已发表报告相比，指南符合率较低。影响FN患者适当抗菌药物处方的因素值得进一步探讨。
